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Vanni T, da Graça Salomão M, Viscondi JYK, Braga PE, da Silva A, de Oliveira Piorelli R, do Prado Santos J, Gattás VL, Lucchesi MBB, de Oliveira MMM, Koike ME, Campos LMA, Coelho EB, Weckx LY, Lara AN, Paiva TM, Timenetsky MDCST, Precioso AR. A randomized, double-blind, non-inferiority trial comparing the immunogenicity and safety of two seasonal inactivated influenza vaccines in adults. Vaccine 2023; 41:3454-3460. [PMID: 37121800 DOI: 10.1016/j.vaccine.2023.04.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 04/02/2023] [Accepted: 04/19/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND To enhance the production and availability of influenza vaccines in different regions of the world is paramount to mitigate the global burden of this disease. Instituto Butantan developed and manufactured an embryonated egg-based inactivated split-virion trivalent seasonal influenza vaccine as part of a technology transfer partnership with Sanofi Pasteur. METHODS This is a phase IV, randomized, double-blind, active-controlled, multicenter clinical trial including adults 18-60 and > 60 years recruited during the 2019 southern hemisphere influenza season. Subjects were randomized 1:1 to receive either the Sanofi Pasteur Trivalent Seasonal Influenza Vaccine (SP-TIV) or Instituto Butantan Trivalent Seasonal Influenza Vaccine (IB-TIV). Hemagglutinin inhibition antibody titers were assessed pre-vaccination and 21 days post-vaccination. RESULTS 624 participants were randomized and vaccinated. In both intention-to-treat and per-protocol analysis, non-inferiority of the SP-TIV versus IB-TIV was demonstrated for the three influenza strains. In the per-protocol analysis, the SP-GMT/IB-GMT ratios for H1N1, H3N2, and B were 0.9 (95%CI, 0.7-1.1), 1.2 (95%CI, 1.0-1.4), and 1.1 (95%CI, 0.9-1.3), respectively. Across vaccination groups, the most common adverse reactions (AR) were limited to the injection-site, including pain and tenderness. The majority of the ARs were graded 1 and/or 2 and lasted less than one day. No serious adverse reaction was observed. CONCLUSION This study demonstrated the non-inferiority of the immunogenicity of a single-dose of Instituto Butantan versus a single dose of the Sanofi Pasteur Seasonal Trivalent Influenza Vaccine in adults. Both vaccines were well tolerated and presented similar safety profiles.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Lucia M A Campos
- Child Institute of the Clinics Hospital of the School of Medicine of University of São Paulo, São Paulo, Brazil
| | - Eduardo B Coelho
- Clinics Hospital of the Medical School of Ribeirão Preto of the University of São Paulo, Ribeirão Preto, Brazil
| | | | - Amanda Nazareth Lara
- Clinics Hospital of the School of Medicine of University of São Paulo, São Paulo, Brazil
| | | | | | - Alexander Roberto Precioso
- Butantan Institute, São Paulo, Brazil; Child Institute of the Clinics Hospital of the School of Medicine of University of São Paulo, São Paulo, Brazil
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Krzywański J, Kuchar E, Pokrywka A, Mikulski T, Pilchowska I, Młyńczak M, Krysztofiak H, Jurczyk J, Ziemba A, Nitsch-Osuch A. Safety and Impact on Training of the Influenza Vaccines in Elite Athletes Participating in the Rio 2016 Olympics. Clin J Sport Med 2021; 31:423-429. [PMID: 32032168 DOI: 10.1097/jsm.0000000000000808] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 09/27/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of the study was to evaluate the safety and tolerance of influenza vaccines for the northern and southern hemispheres in Polish elite athletes participating in the Rio 2016 Olympics. DESIGN Prospective, observational, cohort study. SETTING Institutional level. PARTICIPANTS Ninety-seven athletes vaccinated only with the northern hemisphere vaccine; 98 athletes received the southern hemisphere vaccine alone, whereas 39 athletes were vaccinated with both vaccines. INTERVENTIONS The athletes were vaccinated with a trivalent, inactivated influenza vaccine recommended for the northern hemisphere 2015/2016 and then with the vaccine recommended for the southern hemisphere 2016. Athletes kept a diary of adverse events and effects (if any) on training for 6 days after vaccination. MAIN OUTCOME MEASURES The percentage of general and local adverse events, number of lost or modified training sessions. RESULTS Significantly more local adverse events (pain and redness) were found in the group immunized with the vaccine for the northern hemisphere. There were no differences in the frequency of general adverse events and influence on training between groups. Of total 273 athletes who had 1911 training days during 6 days after vaccination, 6 athletes (2.2%) lost 13 training days (0.7%) and 16 athletes (5.9%) had to modify 34 (1.7%) training days within first 2 days after vaccination. CONCLUSIONS Athletes tolerated influenza immunization well. If they are going to travel to the other hemisphere during the influenza season, the use of the second influenza vaccine should be advised. Athletes should anticipate modification of trainings for 2 days after vaccination.
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Affiliation(s)
| | - Ernest Kuchar
- Department of Pediatrics with Medical Assessment Unit, Medical University of Warsaw, Warsaw, Poland
| | - Andrzej Pokrywka
- National Centre for Sports Medicine, Warsaw, Poland
- Department of Applied and Clinical Physiology, University of Zielona Gora, Zielona Gora, Poland
| | - Tomasz Mikulski
- Department of Applied Physiology, Mossakowski Medical Research Centre Polish Academy of Sciences, Warsaw, Poland
| | - Iwona Pilchowska
- Department of Psychology, SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | - Marcel Młyńczak
- Institute of Metrology and Biomedical Engineering, Warsaw University of Technology, Warsaw, Poland ; and
| | - Hubert Krysztofiak
- National Centre for Sports Medicine, Warsaw, Poland
- Department of Applied Physiology, Mossakowski Medical Research Centre Polish Academy of Sciences, Warsaw, Poland
| | | | - Andrzej Ziemba
- Department of Applied Physiology, Mossakowski Medical Research Centre Polish Academy of Sciences, Warsaw, Poland
| | - Aneta Nitsch-Osuch
- Department of Social Medicine and Public Health, Medical University of Warsaw, Warsaw, Poland
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Mondini G, Braga PE, Lopes MH, Sartori AMC, Miyaji KT, Infante V, Randi BA, Timenetsky MDCST, Ferreira JCDOA, Sakita NK, Precioso AR. Prospective cohort studies to evaluate the safety and immunogenicity of the 2013, 2014, and 2015 seasonal influenza vaccines produced by Instituto Butantan. Rev Inst Med Trop Sao Paulo 2018; 60:e37. [PMID: 30066805 PMCID: PMC6069271 DOI: 10.1590/s1678-9946201860037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 07/02/2018] [Indexed: 11/21/2022] Open
Abstract
Annual vaccination is the most effective way to prevent seasonal influenza illness. Instituto Butantan (IB) performed clinical studies with its 2013, 2014 and 2015 seasonal trivalent influenza vaccines (inactivated split-virion). Prospective cohort studies were carried out to describe the safety and immunogenicity of Instituto Butantan influenza vaccines, in healthy adults and elderly, from 2013 to 2015. Immediately after the informed consent was signed, participants underwent blood collection followed by vaccination. On study days 1, 2 and 3 post-vaccination participants were contacted by the staff to evaluate the occurrence of solicited (local and systemic) and non-solicited adverse reactions. On study day 21 (+7) subjects returned to the clinical site for final safety assessments and blood collection to evaluate post-vaccination immunogenicity. The immunogenicity analyses were performed by means of hemagglutination inhibition (HI) assay. The immunogenicity endpoints were: seroprotection (SPR) and seroconversion (SCR) rates and the geometric mean HI antibody titer ratio (GMTR). The 2013 study was conducted at the Centro de Referência para Imunobiológicos Especiais (CRIE) and at the Centro de Pesquisa Clínica do Instituto da Criança, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo while the 2014 and 2015 studies were conducted at CRIE. The vaccine composition followed the WHO recommendation for the Southern hemisphere seasonal influenza vaccine. Forty-seven healthy adults and 13 elderly participated in the 2013 study, 60 healthy adults and 60 elderly in the 2014 study, and 62 healthy adults and 57 elderly in the 2015 study. In the 2013, 2014 and 2015 studies, pain was the most frequent local adverse reaction and headache the most frequent systemic adverse reaction. All observed adverse reactions were classified as mild or moderate and none as severe. SPR >70% and SPR >60% were observed in adults and elderly, respectively, for the three vaccine viruses, in the 2013, 2014 and 2015 studies. SCR >40% was observed in adults, for the three vaccine viruses, only in the 2014 study and SCR >30% was observed in the elderly, for the three vaccine viruses, only in the 2013 and 2014 studies. GMTR >2.5 among adults, for the three vaccine viruses was only observed in the 2013 study and GMTR >2.0 was observed among elderly, for the three vaccine viruses, in the 2013, 2014 and 2015 studies. The 2013, 2014 and 2015 seasonal influenza vaccines produced by Instituto Butantan were safe and immunogenic according to the immunogenicity criteria defined by the European Medicines Agency (EMA).
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Affiliation(s)
- Gabriella Mondini
- Instituto Butantan, Divisão de Ensaios Clínicos e
Farmacovigilância, São Paulo, São Paulo, Brazil
| | - Patricia Emilia Braga
- Instituto Butantan, Divisão de Ensaios Clínicos e
Farmacovigilância, São Paulo, São Paulo, Brazil
| | - Marta Heloisa Lopes
- Universidade de São Paulo, Faculdade de Medicina, Hospital das
Clínicas, Centro de Referência para Imunobiológicos Especiais (CRIE), São Paulo,
São Paulo, Brazil
| | - Ana Marli Christovam Sartori
- Universidade de São Paulo, Faculdade de Medicina, Hospital das
Clínicas, Centro de Referência para Imunobiológicos Especiais (CRIE), São Paulo,
São Paulo, Brazil
| | - Karina Takesaki Miyaji
- Universidade de São Paulo, Faculdade de Medicina, Hospital das
Clínicas, Centro de Referência para Imunobiológicos Especiais (CRIE), São Paulo,
São Paulo, Brazil
| | - Vanessa Infante
- Universidade de São Paulo, Faculdade de Medicina, Hospital das
Clínicas, Centro de Referência para Imunobiológicos Especiais (CRIE), São Paulo,
São Paulo, Brazil
| | - Bruno Azevedo Randi
- Universidade de São Paulo, Faculdade de Medicina, Hospital das
Clínicas, Centro de Referência para Imunobiológicos Especiais (CRIE), São Paulo,
São Paulo, Brazil
| | | | | | - Neusa Keico Sakita
- Universidade de São Paulo, Faculdade de Medicina, Hospital das
Clínicas, Instituto da Criança, São Paulo, São Paulo, Brazil
| | - Alexander Roberto Precioso
- Instituto Butantan, Divisão de Ensaios Clínicos e
Farmacovigilância, São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Departamento
de Pediatria, São Paulo, São Paulo, Brazil
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Abstract
In spite of current influenza vaccines being immunogenic, evolution of the influenza virus can reduce efficacy and so influenza remains a major threat to public health. One approach to improve influenza vaccines is to include adjuvants; substances that boost the immune response. Adjuvants are particularly beneficial for influenza vaccines administered during a pandemic when a rapid response is required or for use in patients with impaired immune responses, such as infants and the elderly. This review outlines the current use of adjuvants in human influenza vaccines, including what they are, why they are used and what is known of their mechanism of action. To date, six adjuvants have been used in licensed human vaccines: Alum, MF59, AS03, AF03, virosomes and heat labile enterotoxin (LT). In general these adjuvants are safe and well tolerated, but there have been some rare adverse events when adjuvanted vaccines are used at a population level that may discourage the inclusion of adjuvants in influenza vaccines, for example the association of LT with Bell's Palsy. Improved understanding about the mechanisms of the immune response to vaccination and infection has led to advances in adjuvant technology and we describe the experimental adjuvants that have been tested in clinical trials for influenza but have not yet progressed to licensure. Adjuvants alone are not sufficient to improve influenza vaccine efficacy because they do not address the underlying problem of mismatches between circulating virus and the vaccine. However, they may contribute to improved efficacy of next-generation influenza vaccines and will most likely play a role in the development of effective universal influenza vaccines, though what that role will be remains to be seen.
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Affiliation(s)
- John S Tregoning
- a Mucosal Infection and Immunity group, Section of Virology, Department of Medicine , St Mary's Campus, Imperial College London , UK
| | - Ryan F Russell
- a Mucosal Infection and Immunity group, Section of Virology, Department of Medicine , St Mary's Campus, Imperial College London , UK
| | - Ekaterina Kinnear
- a Mucosal Infection and Immunity group, Section of Virology, Department of Medicine , St Mary's Campus, Imperial College London , UK
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